TITLE: A meta-analysis of traditional and functional end-to-side anastomosis in radiocephalic fistula for dialysis access.

OBJECTIVE: Functional vein end to arterial side (ETS) anastomosis uses vein side to arterial side (STS) anastomosis with distal vein ligation, which can achieve similar effects as those of ETS after STS anastomosis. The purpose of the study was to provide a meta-analysis to compare the clinical outcomes between traditional and functional ETS anastomosis in radiocephalic fistula for dialysis access.

METHODS: Databases including PubMed, EMbase, the Cochrane Library, CNKI, Wanfang database were searched from the inception to February 6, 2020. Eligible studies comparing traditional and functional ETS anastomosis in radiocephalic fistula were included. Data were analyzed using Review Manager Version 5.3.

RESULTS: Seven studies were included in the meta-analysis. Five randomized controlled trials and two cohort studies involving 841 patients were identified. Compared with traditional ETS anastomosis, functional ETS anastomosis had shorter anastomosis time (MD - 9.54, 95% CI - 17.96 to - 1.12, P = 0.03), higher surgical success rate (OR 3.80, 95% CI 1.76-8.22, P < 0.01), fewer complications(OR 0.18, 95% CI 0.08-0.39, P < 0.01), higher patency rate after 3 months (OR 4.91, 95% CI 1.19-20.33, P = 0.03), higher patency rate after 6 months (OR 1.90, 95%CI 1.09-3.31, P = 0.02), higher patency rate after 12 months (OR 1.70, 95% CI 1.09-2.66, P = 0.02). There was no difference after the two arteriovenous (AVF) anastomosisl methods concerning AVF maturation time (SMD - 0.48, 95% CI - 1.30-0.34, P = 0.25) and patency rate after 1 month (OR 1.77, 95% CI 0.65-4.80, P = 0.26).

CONCLUSION: Functional ETS anastomosis had advantages of easy operation, high surgical success rate, few complications, high patency rate of 3 months and long-term, but did not have obvious advantage in the early stages concerning AVF maturation time and 1-month patency rate.

SOURCE: Weigang T, Wei X, Lifeng G, et al. A meta-analysis of traditional and functional end-to-side anastomosis in radiocephalic fistula for dialysis access[J]. Int Urol Nephrol, 2021, DOI: 10.1007/s11255-020-02691-9.

目的：改良静脉端至动脉侧（ETS）吻合采用静脉侧至动脉侧（STS）吻合并结扎远端静脉，其效果与STS吻合后的ETS相似。这项研究的目的是提供一项荟萃分析，比较传统的和改良的桡头内瘘的ETS吻合术在进行透析治疗中的临床效果。

方法：从开始到2020年2月6日，检索包括PubMed，EMbase，Cochrane图书馆，CNKI，万方数据库在内的数据库。纳入了比较传统和改良桡头内瘘中ETS吻合的合格研究。使用Review Manager 5.3版分析数据。

结果：荟萃分析包括七项研究。确定了五项随机对照试验和两项涉及841名患者的队列研究。与传统的ETS吻合术相比，改良ETS吻合术时间更短（MD-9.54，95％CI-17.96--1.12，P = 0.03），手术成功率更高（OR 3.80，95％CI 1.76-8.22，P <0.01 ），并发症更少（OR 0.18，95％CI 0.08-0.39，P <0.01），3个月后的通畅率更高（OR 4.91，95％CI 1.19-20.33，P = 0.03），6个月后的通畅率更高（OR 1.90，95％CI 1.09-3.31，P = 0.02），12个月后通畅率更高（OR 1.70，95％CI 1.09-2.66，P = 0.02）。两种动静脉（AVF）吻合方法在AVF成熟时间（SMD-0.48，95％CI-1.30-0.34，P = 0.25）和1个月后通畅率（OR 1.77，95％CI 0.65-4.80）之间没有差异，P = 0.26）。

结论：功能性ETS吻合术具有操作简便，手术成功率高，并发症少，3个月通畅率高，长期有效的优点，但在AVF成熟时间和1个月通畅率方面没有明显优势。

启发：改良端侧在临床中的应用已经越来越多，相对于端端，传统端侧来说，在长期通畅率和手术操作来说，有一定优势。但我们还是要思考一下通畅率优势的源头是什么，手术操作原因还是改变了瘘口的血流动力学？